MATERIALIST APPROACHES: HEALTH AND SOCIETY

“It’s Not the Germs!”

• Etiology – disease causation– Germs, nature, society, individual factors, super-

nature

• Ethnoetiology – local knowledge & practices related to theories of disease causation– Agents (personalistic): contextual (naturalistic)– Internalizing (physiological/internal mechanisms):

externalizing (events outside the body/external pathogenic agencies)

The Blane Report (1977)

• 4 explanations for patterns of inequality in health– Statistical Artefacts: modes of measurement– Outcome of natural or social selection (?)• Health experience upward mobility & unhealthy

downward

– Behavioral or cultural practices – Class and health are linked by structural factors

MATERIALIST/STRUCTURALIST• Emphasizes social, political, economic factors

which adversely affect health• Forms of social/econ./pol. org., environment,

health services, transport, economic conditions, work practices

• We are born into society with a ‘material structure’ (ascribed status?)– ‘shapes us’

• Social org. rather than individual biology• Foundation for health

inequalities/disparities/population health approaches

SOCIAL STRUCTURE, MOBILITY, HEALTH

• Social mobility affected by health• Does not protect against class-based health backgrounds

(ascribed status & health)• “individual lifestyle factors” & the social basis of behavior• Materialist explanations: link social inequality with

biological• Stress & class/ethnicity/gender inequality

– Stress & diabetes• Environment & health• Occupation & health• Food/nutrition & social inequality• Housing & health

Social class?• How to define?

– Occupation, income & wealth, prestige, education, residence, ethnicity, gender, age, ?

• The adjective “Class” – descriptive (many historically anchored)– collectively organized actors (from kinship to caste to class)– people become identified independently of kinship as a constituent of

class– for example, biological differences or functions as defined in the culture

rather than social identities become increasingly important

• Class formation – the formation of collectively organized actors• Class consciousness – the understanding of actors of their class

interests• Class struggle – the practices of actors for the realization of their class

interests– In contest

• Interrelationships of all these

How do we know social classes exist?

• Social stratification• the unequal distribution of goods and services,

rights and obligations, power and prestige• all attributes of positions in society, not attributes

of individuals• there are significant breaks in the distribution of

goods services, rights, obligations, power prestige• as a result of which are formed collectivities or

groups we call strata or “class”

Capitalism, class, health care• Profit & safety; accident & industrial organization

– Not psychological characteristics of the individual• Disease explanations & superstructure (culture & ideology)

– Legitimates status quo as agent of social control– equates hospital care & consumption of drugs as health care– reproduces capitalist class social structure

• Political economy & medicine– Capitalist societies & medicines (profession, technology,

medications)– A class project (struggle) – realization of collective interests– Links economy & politics– Class based monopoloy & profit

• Medical profession central to the control of labor

“health defined”

• Disease – abnormalities• Illness – experience of• Suffering – sickness episodes• Health?– Ability to function– Independence– Both are crucial features of labor in capitalist society

• Medicine works to restore & remedy labor disruptions

Liberalism, Neoliberalism, Health in Capitalist Society

• Liberalism & welfare state capitalism– Liberalism emphasizes individual rights and equality of opportunity– Different forms of liberalism may propose very different policies– Liberalism rejected many foundational assumptions that dominated most

earlier theories of government, such as the Divine Right of Kings, hereditary status, and established religion

• Liberalism: two major streams of thought which compete over the use of the term "liberal" – Classical liberals: only real freedom is freedom from coercion

• state intervention in the economy as a coercive power that restricts the economic freedom of individuals and favor a laissez-faire economic policy

• oppose the welfare state– Social liberals: governments must take an active role in promoting the

freedom of citizens• real freedom can exist only when citizens are healthy, educated, and free from dire

poverty• Government ensures the right to an education, the right to health care, and the

right to a minimum wage.

Liberalism, Neoliberalism, Health in Capitalist Society

• Structuralist basis of welfare state capitalism undermined by decline of industrial sector & globalization of capitalist investment strategies

• State policy now directed at control over costs (rather than provisions) & quantity of health care

• Medicine caught between state & market• From production to consumption as foundation

of class formation in capitalist society

Liberalism, Neoliberalism, Health in Capitalist Society

• Neoliberalism– move from a bureaucratic welfare-based society

toward a meritocracy acting in the interests of business

– based on individual and economic liberty• Health & health care consequences– Individual centric– Achieved health

• Class analysis?